Provider Demographics
NPI:1366501645
Name:NELSON, AMBER L (MPT)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:L
Last Name:NELSON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:L
Other - Last Name:HANLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:730 N HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2045
Mailing Address - Country:US
Mailing Address - Phone:509-458-7686
Mailing Address - Fax:509-458-6611
Practice Address - Street 1:730 N HAMILTON ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2045
Practice Address - Country:US
Practice Address - Phone:509-458-7686
Practice Address - Fax:509-458-6611
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009478225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADB3601OtherRR MEDICARE GROUP
WAG8800296OtherMEDICARE GROUP NUMBER
WAP00429143OtherRR MEDICARE
WA8864703Medicare PIN